A SYSTEMATIC REVIEW OF NONMEDICAL FACTORS INFLUENCING CHINESE PATIENTS’ QUALITY OF LIFE IN THEIR LAST YEAR

Abstract Many studies have demonstrated that healthcare providers’ attention to non-medical issues and involvement in non-medical services can greatly improve the Quality of life (QOL) of dying individuals. Over the past decades, China has made great progress in providing the best possible care for the dying. However, the experiences of Chinese dying persons and their families in the last year of life have not been adequately synthesized. Thus, this systematic review aimed to summarize the last-year experiences of the Chinese dying persons and their families and to identify non-medical factors affecting their QOL. This review followed the PRISMA guideline. Peer-reviewed articles published before November 2022 were searched in both Chinese and English electronic databases. Studies were included if their participants had a life expectancy of one year or less, or family members acting as proxies were asked to recall patients’ experiences during their last year of life. The final review included 24 studies. The findings were classified into four aspects: (1) culture, including filial piety and the importance of family harmony; (2) emotional distress, including feeling like a burden to others, and depressive symptoms; (3) family involvement, including family support and involvement in decision-making; (4) connections to available services, including home-visit nurses and training on caregiving techniques. These findings implied that culturally appropriate non-medical interventions targeted at promoting the mental health of dying individuals, open communication in the family, and connections to available healthcare resources can greatly improve the QOL of dying Chinese persons during their final year of life.


PERCEIVED BARRIERS AND SOCIOCULTURAL FACTORS OF ADVANCE CARE PLANNING AMONG CHINESE AMERICAN OLDER ADULTS
Peiyuan Zhang 1 , Fei Sun 2 , and Jen Hirsch 2 , 1. University of Maryland,Baltimore,Baltimore,Maryland,United States,2. Michigan State University,East Lansing,Michigan,United States Despite documented benefits of advance care planning (ACP), persistent racial and ethnic disparities exist in ACP engagement.This study, guided by a social ecological model, examined perceived barriers and sociocultural factors associated with informal ACP conversations among Chinese American older adults.A purposive sample of 281 community-dwelling older Chinese Americans aged 55 years or older in Arizona and Maryland completed a survey in 2018.The average age of participants was 77.8 (SD = 9.4) and the average number of years living in the U.S. was 24.9 years (SD = 13.4).Most participants were first-generation immigrants (94.7%) and reported Chinese as their primary language (91.8%).About 26.5% of participants had ACP conversations with family.Hierarchical logistic regression results suggest that more perceived barriers were associated with lower odds of ACP conversations (OR = 0.87, p < 0.01).Sociocultural factors were associated with greater odds of ACP conversations, including more years in the U.S. (OR = 1.04, p = 0.02) and English language proficiency (OR = 11.85,p = 0.02).Social support had a significant moderation effect (b = -.01,p < 0.01), indicating a larger effect of perceived barriers on ACP conversations among those with lower social support.Findings highlighted the importance of language services, translated informational materials, and social support in facilitating ACP discussions among Chinese American older adults.Community-based ACP facilitators who have both language skills and cultural competence may be particularly beneficial in engaging this population.Effective ways to reduce barriers to ACP at various levels are needed.Many studies have demonstrated that healthcare providers' attention to non-medical issues and involvement in non-medical services can greatly improve the Quality of life (QOL) of dying individuals.Over the past decades, China has made great progress in providing the best possible care for the dying.However, the experiences of Chinese dying persons and their families in the last year of life have not been adequately synthesized.Thus, this systematic review aimed to summarize the last-year experiences of the Chinese dying persons and their families and to identify non-medical factors affecting their QOL.This review followed the PRISMA guideline.Peer-reviewed articles published before November 2022 were searched in both Chinese and English electronic databases.Studies were included if their participants had a life expectancy of one year or less, or family members acting as proxies were asked to recall patients' experiences during their last year of life.The final review included 24 studies.
The findings were classified into four aspects: (1) culture, including filial piety and the importance of family harmony; (2) emotional distress, including feeling like a burden to others, and depressive symptoms; (3) family involvement, including family support and involvement in decision-making; (4) connections to available services, including home-visit nurses and training on caregiving techniques.Many community organizations serving Korean Americans lack culturally or linguistically tailored services for end-oflife care.Subsequently, Korean American older adults often lack understanding of end-of-life care, particularly advance care planning and hospice.Somang Society is a nonprofit organization serving Korean American older adults and their family caregivers with a mission to promote healthy aging, dignity in later life, and a meaningful death.This study details how Somang Society utilizes education, resources, and volunteer programs to increase the awareness of end-of-life issues among Korean American older adults.The organization provides two distinct community education and volunteer trainings regarding (1) end-of-life care planning program and (2) older adults living with dementia and their family caregivers.They provide community education and volunteer trainings in Korean and expect the volunteers to educate others in the community about the importance of healthy aging, dementia, and advanced care planning.As a result, 15,717 Korean American seniors have filed a living will and advance healthcare directives as of February 2023.In addition, Somang Society emphasizes the importance of wholebody donation for training medical students and healthcare professionals.As a result, 2,134 Korean American seniors have donated or registered for the UCI Willed Body Program through Somang Society since 2008.To further disseminate their programming, the organization actively uses social media to educate Korean Americans on these issues.Their YouTube channel analytics indicate the viewers' positive responses and the potential impact technology usage can have for sharing education with this hard-to-reach population.

NEUROSCIENCE AND AGING Chair: Gregorio Valdez
In this symposium, experts will highlight discoveries that are beginning to bridge the gap between basic neuroscience research and development of therapies to mitigate the ravages of normal aging and age-associated neurological diseases on the nervous system.The symposium will cover cellular, molecular and behavioral approaches to researching aging of the nervous system.It will provide insights about how aging impacts the fate of neurons and their synapses and how age-related changes in cellular maintenance, molecular signaling, and glial function ultimately diminish cognitive and motor function.Dr. Miranda Orr will provide insights about the contribution of senescent cells to age-and disease-associated degeneration of the nervous system.Dr. Julie Andersen will present on how cells in the nervous system use their own organelles to repair damages to avoid dysfunction during aging and in Alzheimer's Disease.Dr. Gregorio Valdez will review recent discoveries revealing the initial cellular and molecular changes that impair voluntary movements during aging.Dr. Scott Pletcher will present evidence that cellular and molecular processes important for feeding, mating and avoiding danger in flies also play key roles in healthy aging of the nervous system.The information provided by the speakers will foster discussion among all attendees about the challenges and opportunities to accelerate translation of discoveries to protect the nervous system from aging and associated diseases.

BLUEPRINT TO TARGET THE SPINAL CORD MOTOR CIRCUITRY TO PRESERVE AND RESTORE MOBILITY IN OLD AGE Gregorio Valdez, Brown University, Providence, Rhode Island, United States
Spinal motor neurons are central for the initiation and modulation of all voluntary movements.Within the spinal cord, motor neurons form tens of thousands of excitatory (glutamatergic and cholinergic) and inhibitory (GABAergic and glycinergic) synapses along their dendritic arbor and soma.These synapses contain the information required to execute fine and complex motor commands and are together referred to as the motor circuitry.Once activated, motor neurons drive muscle contraction by releasing neurotransmitters from their axon terminals at neuromuscular junctions (NMJs).Thus, either the death of motor neurons or their disconnection from other neurons are skeletal muscles during aging would undoubtedly compromise motor function.We will show that motor neurons do not die in old female and male mice, rhesus monkeys, and humans.Instead, these neurons selectively and progressively shed excitatory synaptic inputs throughout the soma and dendritic arbor during aging.Thus, aged motor neurons contain a motor circuitry with a reduced ratio of excitatory to inhibitory synapses that may be responsible for the diminished ability to activate motor neurons to commence movements.Additionally, we will show that aged motor neurons present with aberrant changes in genes and molecular pathways with roles in glia-mediated synaptic pruning, inflammation, axonal regeneration, and oxidative stress.I will bring these findings together to suggest that motor neurons at a minimum contribute to the loss of their own synapses with advancing age and discuss possible avenues for therapeutic intervention.

Abstract citation ID: igad104.0727 A SYSTEMATIC REVIEW OF NONMEDICAL FACTORS INFLUENCING CHINESE PATIENTS' QUALITY OF LIFE IN THEIR LAST YEAR Shuo
These findings implied that culturally appropriate non-medical interventions targeted at promoting the mental health of dying individuals, open communication in the family, and connections to available healthcare resources can greatly improve the QOL of dying Chinese persons during their final year of life.